Hospitals may end be over crowded tonight as they fail to discharge patients because of the junior doctor strike.

The NHS seemed to cope well on Wednesday following the walkout from 08:00 GMT over the contract dispute. But NHS England said the second day of the 48 hour walkout in England was always going to be more difficult.

Officials said hospitals may struggle to discharge patients without junior medics on wards.

Dr Anne Rainsberry, who is in charge of planning during the strike, suggested hospitals might find it difficult to discharge patients, which could then create a backlog in hospital wards.

She said this was because they had a “valuable role” in chasing up test results and ensuring patients were ready for discharge.

“So far the NHS is holding up, but we always expected the second half of the strike will be more challenging,” she said.

She also urged patients to go to hospital only when absolutely necessary.

“If people need medical help and it’s not an emergency they should consider NHS Choices, visit their local pharmacy, or call their GP or NHS 111 for more serious matters. If their condition is an emergency or life-threatening they should call 999 as usual or go to A&E.”

Doctors are providing emergency cover during the walkout, which ends on Friday morning, and consultants, nurses and midwives are all working in hospital as normal. GP surgeries are largely unaffected.

On Wednesday just over half of junior doctors expected in work did not turn up – a figure broadly in line with the previous strikes and to be expected considering the numbers needed to provide emergency care.

The latest walkout is the third in the long running dispute, but the first to last 48 hours.

So far 19,000 operations and treatments have had to be postponed because of industrial action. The NHS carries out about 30,000 procedures a day.

Thousands of check-ups, appointments and tests have been affected as well.

Katherine Murphy, of the Patients Association, said she had “growing concern” about the dispute.

“Whatever the rights and wrongs of the arguments put forward by either side, the failure to resolve the differences by agreement is bad for doctors, bad for the taxpayer, but above all bad for patients and the NHS.”

This week’s walkout is the first of three 48 hour stoppages planned by the British Medical Association as it continues its fight against the government’s plans to force through the changes to pay and conditions. The next two are planned for April.

The union has also said it will be launching a legal challenge to oppose the imposition of the contract that was announced following last month’s strike.

But ministers have said they will be pushing ahead with imposition regardless. The new contracts are due to go out in May and will come into force from August.

The BMA said it “deeply regretted” the disruption that was being caused, but the action was necessary because of the “unfair” changes being imposed on the profession.

Hospital visits for alcohol poisoning have doubled in six years- with the highest rate among females aged 15 to 19.

With the holiday season on us emergency admissions due to the effects of alcohol, such as liver disease, have also risen by more than 50% in nine years to 250,000 a year in England.

Rates were highest in deprived areas and in the north, and among men aged 45-64, the Nuffield Trust revealed.

The Nuffield Trust said their figures were an underestimate of the impact of drinking because they did not include alcohol -fuelled falls and fights, just illnesses such as alcohol poisoning and liver disease.

Nor do they count people who come to A&E drunk and are then sent home without being treated or admitted as a patient.

Half of all A&E attendances likely to be due to alcohol poisoning – when a person drinks a toxic amount of alcohol, usually over a short period of time – took place on a Friday, Saturday or Sunday, peaking between midnight and 2am.

Three in four arrived by ambulance – putting a strain on already stretched resources, said the Nuffield Trust.

Young women aged 15 to 19 were admitted to hospital for alcohol poisoning 1.4 times as often as young men in the same age group.

A&E attendance rates that are likely to be due to alcohol poisoning and emergency hospital admissions linked to alcohol were three to four times higher in the poorest fifth of the population, the figures showed.

The report also reveals the number of people actually being admitted to hospital with alcohol-related problems, such as liver disease.

Men aged between 45 and 64 made up the largest share of this group.

Joint author of the report Claire Currie said: “With the Christmas party season in full swing, it’s worth considering the full burden over-indulgence in alcohol is placing on our NHS, as well as the obvious human cost.

“Our research has uncovered a picture of rising and avoidable activity in hospitals, representing a stark challenge for the Health Service at a time when it’s already great pressure. Hospitals alone cannot tackle this issue – the government must consider measures such as minimum unit pricing, restricting availability and limiting marketing and advertising.”

In England in 2013, approximately 18% of men and 13% of women drank at a level considered to be putting them at increased risk of harm.

In 2013/14, approximately 1 in 20 emergency admissions in England were related to alcohol.

Figures from the Office for National Statistics suggest binge-drinking among young adults in Britain is continuing to fall, and more than a fifth of UK adults now say they do not drink alcohol at all.

A government spokesman said: “People should always drink alcohol responsibly – very busy ambulance services and A&E staff can do without this extra demand.

“The government has taken action to tackle cheap alcohol by banning the lowest priced drinks and we are already seeing fewer young people drinking on a regular basis.”

Foreign patients could be charged for emergency treatment under new government plans for the NHS in England.

Visitors from outside the European Economic Area already pay for planned hospital care. The EEA covers the European Union, Iceland, Liechtenstein and Norway.

Health Secretary Jeremy Hunt wants to save the NHS millions of pounds by extending the charges to A&E care. A consultation is expected to be set up in the next few weeks.

Overseas visitors can currently receive A&E treatment, ambulance services and GP visits free of charge, but if the plans go ahead some treatment could be withheld until fees are paid.

The Department of Health said exemptions would be put in place for refugees and asylum seekers, and pregnant women would not be turned away from maternity units if they had not paid upfront.

A department spokesman said: “International visitors are welcome to use the NHS, provided they pay for it – just as families living in the UK do through their taxes.”

“This government was the first to introduce tough measures to clamp down on migrants accessing NHS care and have always been clear we want to look at extending charges for non-EEA migrants.”

“No-one will be denied urgent treatment and vulnerable groups will continue to be exempt from charging.”

All visitors to the UK and British expats are charged 150% of the cost of non-emergency NHS treatment in order to discourage people travelling to the UK just to use health services – so-called “health tourism”.

The latest crackdown is expected to reclaim around £500 million.

A spokesman for the Royal College of Emergency Medicine told the newspaper that A&E doctors “cannot reasonably be expected to take on the burden of identifying who is eligible for free treatment, and who should be charged”.

The British Medical Association agreed, saying: “A doctor’s duty is to treat the patient in front of them, not to act as border guard. Any plans to charge migrants and short-term visitors need to be practical, economic and efficient.”

In April new rules came into force which mean non-EU citizens settling in the UK for longer than six months are required to pay a “health surcharge” as part of their visa applications.

The NHS could save £27 million a year by changing the way it deals with alcoholic patients.

Alcohol abuse costs the NHS £3.8 billion a year, £145 for each UK household. One in three of all A&E admissions are alcohol related- but on a weekend that can rise to 70%.

Dr Chris Daly, the lead consultant at the unit, believes the NHS is wasting money by often treating people for the effects of alcohol problems without dealing with the underlying problem.

“We were very surprised that a significant proportion, maybe as much as 50% of the patients that we see, were not open to any services and some of them had never been seen by alcohol services before, so it’s almost as if we’re dealing with a different sort of population,” he says.

“These are people who are maybe only using their A&E department as their main source of treatment for their alcohol problems.”

The Radar ward at Chapman Barker is the first of its kind in the UK. Set up three years ago it takes alcohol dependent patients directly from 11 A&E departments across Manchester.

Some 75% of the people who come through the unit do not go back to hospital for at least the next three months.

The Radar ward is split with separate eating and living spaces for both sexes. Four in 10 of the places here are taken by women, from teenagers right up to pensioners in their 80s.

Patients are treated with talking therapies, support and counselling, but also specialist medical care they would not always get in a large hospital.

Around half of all alcohol dependent patients can develop clinical symptoms when they try to quit, including seizures, fits and hallucinations.

Without the right support the most severe cases often end up back in hospital.

An independent analysis of the unit by academics at Liverpool John Moores University published in April 2015 found it saves the NHS £1.3 million a year.

If the same approach was taken across the country the researchers say it could save the NHS £27.5 million in England alone.

This unit has secured funding to operate for another year but the future is always uncertain. The people working there say ignoring these patients will cost the NHS more in the long run.

Health Direct repeats numerous research warnings that alcohol is the drug that causes the most damage to the UK population- so anything that curbs preventable crisis is to be welcomed.

The NHS has had it’s hardest difficult winter for a long time- so haow has it coped?

The four hour target to be seen in A&E has been missed in each nation – and that has had a knock-on effect on other parts of the hospital system.

In England all the evidence points to it being the worst winter since the target was introduced at the end of 2004.

The target is officially measured on a quarterly basis and covers the point from arrival to when a patient is discharged, transferred elsewhere or admitted into hospital for further treatment, .

During the last three months of 2014 92.6% were seen within four hours – the worst figure during this whole period.

We will have to wait until the end of March to get the next quarterly data, but performance is on track to be even worse than that.

And NHS England has already admitted the average for the whole of 2014-15 will be below 95% – the first time this has happened for a whole year under the target.

The situation was particularly bad at the turn of the year. A number of hospitals had to declare major incidents, a move normally associated with accidents involving multiple injuries.

To the NHS’s credit, performance did pick up after that point – although not enough to return above the 95% mark.

However, it is worth noting that the UK’s National Health Service has one of the toughest waiting time measures in the world.

Another way to look at it is to see the performance of individual trusts. Take a look at this chart.

England – as the biggest health service and the one that produces the most up-to-date data – has received the most attention.

But the problems have been just as acute elsewhere in the UK. In fact, England could be said to have faired the best.

In January waiting times reached their worst levels in Wales since the current way of recording performance was introduced in 2009.

It got so bad that one police force reported it had had to start taking people to hospital because there weren’t enough ambulances.

Of course, A&Es do not work in isolation and so, unsurprisingly, other parts of the hospital system have experienced problems.

Analysis by the House of Commons Library shows how such pressure points got worse this winter between November and March.

The simple answer is the number of people coming to A&E has gone up. Take a look at these figures.

Between November and February just over 7m visits were made to A&Es in England – 190,000 more than the year before.
The busiest week – the one ending 21 December – saw 446,000 people arrive, up by nearly 10% on the same week the year before and the highest ever recorded.

There were 1.82m emergency admissions – the most complicated cases that cannot be dealt with by A&E – up 51,000 on last year.

But this winter there has also been heated debate about what other factors may have played a role. These have ranged from the new 111 urgent phone service not being as good as it should to problems accessing social care and GPs.

Last spring and summer were also difficult, with the target being missed several times in England.

What is more, Scotland, Northern Ireland and Wales are all still a long way from achieving the target. The A&E story is unlikely to go away just yet.

More patients had to wait over 12 hours for treatment at seven of Northern Ireland’s A&E departments in January.

Department of Health figures show that 380 people waited more than 12 hours, compared to 92 in the previous month.

In January, 54,910 people went to emergency departments compared to 56,656 in December. The Ulster Hospital had the biggest rise in those waiting longer than 12 hours and Antrim Area Hospital had the biggest fall.

There was also a fall in the percentage of people seen and treated within four hours, from 73.5% in December to 71.4% in January. The target is 95%.

Figures released in December showed that Northern Ireland was the worst performing region in the UK for seeing patients in emergency departments within the four hour target.

The Health and Social Care Board said it had been a challenging month, with significant pressures during the first week of January coming after a two week period of substantially increased demand.

Chief executive Valerie Watts said delays were regrettable, but “it must be noted that significantly fewer people are waiting over 12 hours in emergency departments, compared to five years ago”.

“In 2011/12, over 10,000 patients waited longer than 12 hours in our emergency departments – that had almost halved in 2012-13 to 5,500 and was just over 3,000 last year,” she said.

Ms Watts said the board had been working closely with trusts to alleviate pressures in emergency departments and throughout the hospital system.

Hospitals like the Cheltenham General Hospital are being closed to new patients and routine operations- but why?

Primarily hospitals are all about flow- as new patients arrive, others must move on through the system and, eventually, leave. But what has happened in the past month is that the system has stalled.

Last year more than 14 million patients arrived at A&E – effectively the front door of the hospital.

Most of those are dealt with by the doctors and nurses in A&E. But one in four need more complicated care than can be given so are admitted into the hospital. These tend to be the frailest and most vulnerable patients.

Once the decision has been made to admit them, those patients need to be found a bed. When that has happened, they can receive their treatment and, once they are ready, leave the hospital.

With A&E units full, ambulances have found it difficult to drop off patients. When they turn up at hospital, it is only meant to take 15 minutes to handover a patients.

But over the last four weeks there were over 37,000 occasions when ambulances were left waiting for over 30 minutes. That is more than double the number the year before.

Once inside A&E the delays have continued – as we know from the extensive coverage given to how the NHS has been struggling to meet its four-hour target.

A growing number of those that are then admitted into hospital are facing long waits (over four hours) for a bed to be found. These are sometimes known as trolley waits. During the last four weeks the number of these has trebled from last year to over 47,000.

But it doesn’t end there- when patients are ready to be discharged, delays are once again being experienced.

The frailest and most vulnerable patients need care to be in place in the community either via council-run social care teams or local NHS services before they can be released.

If it isn’t available, they have to stay in hospital. The NHS measures this as bed days lost due to delayed discharge. There were over 62,000 of these over the past four weeks – up by nearly a third.

This creates a scarcity of beds. The effect of this is two-fold. Firstly, hospitals are forced to put emergency patients in whichever ward they can find a bed, which means patients do not always end up in the place that is most appropriate for them.

This is not good for patients or for the effective running of the hospital. Doctors and nurses waste time going on what are known as “safari rounds” looking for their patients that can be spread across many different areas. In short, the hospital stops running smoothly.

The problems also have an impact on the non-emergency side of the system. One step that is taken is that routine operations, such as knee and hip replacements, are cancelled.

It is this catalogue of problems that prompts hospitals to raise the alarm. In recent weeks a number of trusts have even been forced to declare major incidents – like the Cheltenham General Hospital- which should be something normally reserved for major accidents, like train crashes.

The most common reason put forward for the problems has been the rise in attendances. But what seems remarkable when you look at the figures is that the increase in those seems extremely small by comparison.

They have only risen by 7% on last winter. But that is significant because it equates to more than 100,000 patients.

And in the case of the Cheltenham hospital it is compounded because the local health trust want to close the A&E department completely- to save money and move all emergencies to just one hospital in Gloucestershire- which is currently loss making.

The Police rather than the NHS should be dealling with drunks claims the AnE boss.

Police should crack down on binge drinking to stop hospital staff being distracted by disorderly drunks according to a leading doctor.

Dr Clifford Mann, president of the College of Emergency Medicine, said the “softer approach” used for anti-social drunkenness did not seem to be working. Police could instead increase arrests, convictions and fines, he suggested.

Crime prevention minister Lynne Featherstone said the government was “determined to tackle alcohol-fuelled harm”, which she said cost society around £21 billion a year.

The coalition had improved the powers available to the police and licensing authorities to tackle alcohol-related crime, and had banned the “worst cases of very cheap and harmful alcohol sales”, the Liberal Democrat MP said.

Dr Mann said: “All I am saying at the moment is the softer approach – where we don’t any longer arrest many people for being drunk and disorderly – certainly doesn’t seem to be working.”

He said the number of people arriving at A&E units while drunk was increasing year on year, while the number of licensed premises in the UK was also increasing and alcohol was getting cheaper.

“I think these people, by the nature of the disorder, they are distracting medical and nursing staff from looking after other patients and therefore are wasting public resources,” he said.

“I think they therefore fall into the category of being drunk and disorderly in their behaviour and the police can act to take them away.”

Health Direct agrees with the suggestion. To use the Greens’ parlance of “the polluter should pay”- the drunks should be charged- literally and financially. Until the politicians, police and society in general starts to deal appropriately of issue of people drinking too much alcohol then it is unfair and detrimental to the expect the NHS to pick up the pieces.

Not only would this approach save the NHS money- but the police and courts would make money by fining people who have paid to incapacitate themselves- and who are after all breaking the law.